Provider Demographics
NPI:1598958647
Name:MOORE, KELLEY NEWMAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:KELLEY
Middle Name:NEWMAN
Last Name:MOORE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 ORANGE AVE
Mailing Address - Street 2:
Mailing Address - City:ROCKLEDGE
Mailing Address - State:FL
Mailing Address - Zip Code:32955-2945
Mailing Address - Country:US
Mailing Address - Phone:321-632-2020
Mailing Address - Fax:
Practice Address - Street 1:1 ORANGE AVE
Practice Address - Street 2:
Practice Address - City:ROCKLEDGE
Practice Address - State:FL
Practice Address - Zip Code:32955-2945
Practice Address - Country:US
Practice Address - Phone:321-632-2020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-22
Last Update Date:2007-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN15054122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist